Free Nursing Acceleration Challenge Exam (ACE) Practice Test
1. At which time of day are patients with cognitive impairment usually MOST sensitive to sensory overload?
b. Early morning
c. Late evening
2. Which of the following is characteristic of nociceptive pain?
a. Acute aching or throbbing pain localized to the site of injury
b. Diffuse or cramping pain
c. Association with chronic conditions such as diabetes or cancer
d. Burning, stabbing, or shooting pains
3. According to the three-step World Health Organization (WHO) "analgesic ladder," a patient complaining of moderate to severe pain unresponsive to NSAIDs may require which of the following medications?
4. Which type of precautions is indicated for a patient with a surgical-site infection and purulent discharge?
c. Contact and droplet
5. Which of the following injection sites is the BEST choice for intramuscular (IM) administration of 3 mL of medication for a well-developed adult female of normal weight?
a. Ventrogluteal site
b. Dorsogluteal site
c. Vastus lateralis
Answers & Explanations
1. D: Many people are more sensitive to sensory overload in the afternoon when cortisol levels are highest. Sensory overload most often affects those with cognitive impairment or those in stressful situations. Excess noise and activity can cause distress, agitation, confusion, and delirium. Sensory deprivation occurs when there is too little environmental stimulation because of reduction in sensory input because of hearing or vision deficits, inability to recognize sensory input because of cognitive impairment, or a boring environment. Sensory deprivation can contribute to confusion, disorientation, and depression.
2. A: Nociceptive pain usually correlates with the extent and type of injury: the greater the injury, the greater the pain. It may be procedural pain (related to wound manipulation and dressing changes) or surgical pain (related to the cutting of tissue). It may also be continuous or cyclic, depending upon the type of injury. This type of pain, often described as aching or throbbing, is usually localized to the area of injury and resolves over time as healing takes place, and it usually responds to analgesia.
3. B: Codeine. Systemic medications may be given orally or by injection into muscles, subcutaneous tissue, or veins to control pain. World Health Organization (WHO) pain classifications include the following:
- Step 1: Mild to moderate pain is treated with aspirin, acetaminophen, and NSAIDs.
- Step 2: Moderate to severe pain unrelieved by Step 1 medications may need opioids, such as codeine, tramadol, or Percocet.
- Step 3: Severe pain without relief from Step 1 or Step 2 medications may need stronger opioids, such as morphine, Dilaudid, or MS-Contin.
4. D: Contact precautions
Use personal protective equipment (PPE), including gown and gloves, for all contacts with the patient or the patient's immediate environment.
Maintain patient in private room or more than three feet away from other patients.
(Appropriate for influenza, streptococcus infection, pertussis, rhinovirus, and adenovirus and pathogens that remain viable and infectious for only short distances.)
Use a mask while caring for the patient. Maintain patient in a private room or more than three feet away from other patients with a curtain separating them.
Use a mask for the patient if transporting the patient from one area to another.
Appropriate for measles, chickenpox, tuberculosis, and severe acute respiratory syndrome (SARS) because pathogens remain viable and infectious for long distances.
Place the patient in an airborne infection isolation room.
Use N95 respirators (or masks) while caring for the patient.
5. A: The ventrogluteal site is the preferred IM injection site because there is little danger of injecting into fatty tissue, large nerves, or blood vessels. In a well-developed adult, up to 4 mL can be safely injected. The dorsogluteal site is the least preferred site because of its proximity to the sciatic nerve and large blood vessels and increased fat deposits. The vastus lateralis site is also good because it lacks large nerves or large blood vessels. The deltoid site is usually avoided because of the small muscle size and the proximity of the radial nerve and artery. Injections to the deltoid should be limited to 1 mL.
Last Updated: 07/05/2018